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Hypertension poorly responsive to medications is defined resistant hypertension. We have previously shown that 1-year of guided walking is followed by highly significant reduction of systolic blood pressure in hypertensive subjects. Aim of this study was to assess the effect of a 1-year of guided walking on the blood pressure of sedentary hypertensive subjects including patients with resistant hypertension. Two hundred and fifty-nine sedentary subjects with systolic pressure ≥130 mmHg were subdivided in a group without blood pressure medications and in a group taking three or more antihypertensive drugs, including diuretics. Blood pressure, body weight, body mass index, waist circumference, and walking speed were determined at enrollment and after 1-year of walking, supervised by exercise physiologists. At baseline, systolic pressure was significantly higher in the subjects under therapy (144.6 ± 12.2 vs. 140.2 ± 10.7). Two hundred and three subjects (124 without and 79 with therapy) completed the program. During the 1-year program each subject walked ~220 h. After 1-year a significant decrease (P < 0.0001) of systolic pressure was observed in both groups. The decrease was significantly higher (P < 0.0001) in the subjects under therapy. The decrease of systolic pressure was directly proportional to baseline values. Diastolic blood pressure decreased significantly in both groups. In conclusion, habitual walking may lead to clinically significant reductions of blood pressure in therapy resistant hypertensive subjects.

Background: The walking speed maintained during a moderate 1-km treadmill walk (1k-TWT) has been demonstrated to be a valid tool for estimating peak oxygen uptake (VO2peak), and to be inversely related to long-term survival and hospitalization in outpatients with cardiovascular disease (CVD). We aimed to examine whether 500-meters and 1-k moderate treadmill-walking tests equally estimate VO2peak in male outpatients with CVD., Methods: One hundred forty-two clinically stable male outpatients with CVD, aged 34-92 years, referred to an exercise-based secondary prevention program, performed a moderate and perceptually-regulated (11-13/20 on the Borg Scale) 1k-TWT. Age, height, weight, time to walk 500-meter and the entire 1000-meter, and the corresponding heart rates were entered into validated equations to estimate VO2peak., Results: VO2peak estimated from the 500-meters test was not different from that estimated from the 1k test (25.2±5.1 vs. 25.1±5.2 mL/kg/min). The correlation coefficient between the two was 0.98. The slope and the intercept of the relationship between the 500-meter and 1k tests were not different from the line of identity. Bland-Altman analysis demonstrated that 96% of the data points were within two standard deviations (from -1.9 to 1.7 mL/kg/min)., Conclusions: The 500-meter treadmill-walking test is a reliable method for estimating VO2peak in stable male outpatients with CVD. A shorter version of the test, 500-meter, provides similar information as that from the original 1k test, but is more time efficient. These findings have practical implications in the context of transitioning patients from clinically based and supervised programs to fitness facilities or self-guided exercise programs.

Background: Maximal cardiopulmonary exercise testing (CPX) is the gold-standard for cardiorespiratory fitness assessment in chronic heart failure (CHF) patients. However, high costs, required medical supervision, and safety concerns make maximal exercise testing impractical for evaluating mobility-impaired adults. Thus, several submaximal walking protocols have been developed and currently used to estimate peak oxygen consumption (VO 2 peak) in CHF patients. However, these tests have to be performed at close to maximum exercise intensity. The aim of this study was to examine the validity of a 500-m treadmill-walking test carried out at moderate intensity for estimating VO 2 peak in community-dwelling adult and elderly patients with CHF and reduced left ventricular ejection fraction (HFrEF)., Methods: Forty-three clinically stable men with HFrEF (age 67.7 ± 9.2 years, and left ventricular ejection fraction, LVEF 38% ± 6%) underwent exercise testing during an outpatient cardiac rehabilitation/secondary prevention program. Each patients completed a CPX, and a moderate and self-paced (11-13/20 on the Borg scale) 500-m treadmill-walking test. Age, weight, height, walk time, and heart rate during the 500-m test were entered into prediction equations previously validated for VO 2 peak estimation from a 1000-m walking test in patients with cardiovascular disease and preserved LVEF., Results: Directly measured and estimated VO 2 peak values were not different (21.6 ± 4.9 vs 21.7 ± 4.6 mL/kg/min). The comparison between measured and estimated VO 2 peak values yielded a correlation of R = 0.97 (SEE = 0.7 mL/kg/min, P < 0.0001). The slope and the intercept coincided with the line of identity (Passing and Bablock analysis, P = 0.50). Residuals were normally distributed, and the examination of the Bland-Altman analysis do not show systematic or proportional error., Conclusions: A moderate and self-regulated 500-m treadmill-walking test is a valid tool for VO 2 peak estimation in patients with HFrEF. These findings may have practical implications in the context of transitioning from clinically based programs to fitness facilities or self-guided exercise programs in adults and elderly men with HFrEF.

Objectives: To determine the prognostic ability of established percent-predicted equations of peak oxygen consumption (%PRED) estimated by a moderate submaximal walking test in a large cohort of outpatients with cardiovascular disease (CVD)., Design: Population-based prospective study., Methods: A total of 1442 male patients aged 25-85 years at baseline, underwent a moderate perceptually-regulated (11-13 on the 6-20 Borg scale) treadmill walk (1k-TWT) for peak oxygen consumption estimation (VO 2 peak). %PRED was derived from ACSM, Ades et al, Morris et al, and the Wasserman/Hansen equations, and their prognostic performance was assessed. Overall mortality was the end point. Participants were divided into quartiles of %PRED, and mortality risk was estimated using a Cox regression model., Results: During a median 8.2year follow-up, 167 all-cause deaths occurred. The Wasserman/Hansen equation provided the highest prognostic value. Mortality rate was lower across increasing quartiles of %PRED. Compared to the first quartile, after adjustment for confounders, the mortality risk decreased for the second, third, and fourth quartiles, with HRs of 0.75 (95% CI 0.44-1.29, p=0.29), 0.67 (95% CI 0.38-1.18, p=0.17), and 0.37 (95% CI 0.10-0.78, p=0.009), respectively (p for trend <0.0001). Each 1% increase in %PRED conferred a 4% improvement in survival., Conclusions: The percent-predicted VO 2 peak determined by Wasserman/Hansen equations applied to the 1k-TWT is inversely and significantly related to survival in cardiac outpatients. The 1k-TWT is a simple and useful tool for stratifying mortality risk in patients participating in secondary prevention programs., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objective: To determine the relationship between walking speed (WS) maintained during a 1 km test and its improvement on hospitalisation in cardiac outpatients who were referred to an exercise-based secondary prevention programme., Methods: Hospitalisation was assessed in 1791 patients 3 years after enrolment and related to the WS achieved during a 1 km walk at moderate intensity on a treadmill. Hospitalisation was also assessed during the fourth-to-sixth years as function of improvement in WS in 1111 participants who were re-evaluated 3 years after baseline., Results: Three-year hospitalisation rate across tertiles of baseline WS was 50% for the slow walkers (2.7±0.6 km/hour), 41% for the moderate (4.1±0.3 km/hour) and 25% for the fast walkers (5.2±0.5 km/hour) (p for trend <0.0001), with adjusted HRs (95% CI) of 0.93 (0.74 to 1.17, p=0.53) for intermediate and 0.58 (0.43 to 0.78, p=0.0003) for fast. Every 1 km/hour increase in WS was associated with a 21% reduction in hospitalisation (p<0.0001). Hospitalisation from the fourth-to-sixth years was lower across tertiles of improved WS, with 44% for the low (0.2±0.4 km/hour), 34% for the intermediate (0.8±0.2 km/hour) and 30% for the high tertile (1.6±0.4 km/hour) (p for trend <0.0001). Adjusted HRs were 0.68 (p=0.002) for the intermediate and 0.58 (p<0.0001) for the high tertile. Every 1 km/hour increase in WS was associated with a 35% reduction in hospitalisation (p<0.0001)., Conclusion: Improvement in WS is associated with a significant, dose-dependent lower rate of all-cause hospitalisation in cardiac outpatients. WS is a simple, easily applied and clinically useful tool for cardiac patients undergoing secondary prevention., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Purpose: To determine whether a moderate 1-km treadmill walking test (1KTWT) could be used to predict peak oxygen uptake VO(2)peak) in patients with cardiovascular disease., Methods: One hundred seventy-eight male patients, aged 38 to 83 years, completed a VO(2)peak treadmill test and a 1KTWT using a self-regulated intensity of 11 to 13 of 20 on the Borg scale. Multivariable regression analysis was used to develop equations for predicting VO(2)peak in a development group (n = 110), both for subjects prescribed and not prescribed a β-blocking agent (BB/NBB, 66/44). These equations were then applied to a cross-validation and reproducibility group (n = 68, BB/NBB, 37/31), who completed the protocol twice within 2 weeks., Results: Analysis from 1KTWT in the development group showed that age, body mass index, walking speed, and heart rate were the most potent predictors of VO(2)peak. Measured and predicted VO(2)peak were not significantly different, and were strongly associated among both the NBB (r = 0.81, P < .0001) and BB (r = 0.69, P < .0001) groups, with a mean residual of approximately 1.0 mL·kg(-1)·min(-1). When applied to the cross-validation and reproducibility group, the equations similarly yielded strong associations (r = 0.64, P < 0.001 and r = 0.71, P < 0.001 for the NBB and BB groups, respectively), with no significantly differences between measured and predicted VO(2)peak. Mean test-retest differences for measured and predicted VO(2)peak were between 0.1 and -0.5 mL·kg(-1)·min(-1)., Conclusions: Equations developed from the 1KTWT accurately predicted VO(2)peak in patients with cardiovascular disease. The model may represent a valid, low cost, and simple tool for indirect estimations of cardiorespiratory fitness in an outpatient setting.

Background: Exercise training reduces walking disability in peripheral arterial disease (PAD). This non-randomized study evaluates the effects on walking ability and hemodynamic parameters of a novel approach to home-based rehabilitation, the test in -train out program (Ti-To), compared with the traditional home-based free walking exercise (Tr-E)., Methods and Results: A total of 143 patients with claudication (117 men, average age 68+/-10 years), were included in a Ti-To (n=83) or Tr-E program (n=60). Evaluations, which were carried out upon entry and at 1, 2, 3, 4 and 6 months, included: self-reported claudication, walking ability (ie, absolute claudication distance, pain threshold speed), resting/exercise heart rates (HR), systolic/diastolic brachial pressure (SBP/DBP), ankle pressure (AP), ankle-brachial index (ABI). Ti-To involved 2 daily 10-min home walking sessions at maximal asymptomatic speed and the patient attending monthly check-ups at hospital. Tr-E involved 20-30 min of daily walking at self-selected speeds up to pain tolerance. A total of 126 patients (Ti-To, n=74; Tr-E, n=52) completed the program. Ti-To induced better relief from claudication (p=0.001). Functional parameters improved significantly for both groups (p<0.0001) with significant intergroup difference for Ti-To (p<0.0001). SBP and exercise HR decreased significantly in both groups, with Ti-To improving resting HR (p=0.0002), DBP (p=0.003), lowest AP worse limb (p=0.004) and ABI worse limb (p=0.0002)., Conclusions: In patients with PAD, a Ti-To program had more positive effects on perceived claudication, and functional and hemodynamic parameters than did a Tr-E program.

The purpose of this study was to develop a test for identifying the speed of onset of claudication, or pain threshold speed (PTS), in 16 patients affected by intermittent claudication. An echo-Doppler examination and the ankle-brachial index (ABI) determination were also performed. Test repeatability was evaluated in 10 patients retested within a few days. All 16 patients underwent the incremental walking test 3 times during a 6-month rehabilitation training program to verify the test's sensitivity in detecting the expected functional modifications. PTS was identified in all patients examined and the test-retest correlation coefficient (R) for PTS was 0.98. During the 6-month rehabilitation period, the ABI rose from 0.43 +/-0.16 to 0.72+/-0.15 for the worst limb and PTS also rose significantly from 3.9+/-1.4 km/h to 6.1+/-1.1 km/h. The average increments of ABI and PTS were significantly correlated. An incremental walking test for the identification of the walking speed at which claudication occurs has been developed. The PTS is a reproducible parameter that can be combined with other test results to establish the severity of the disease and to check any modifications that occur during rehabilitation.